USMLE - Pathology Flashcards
(181 cards)
0
Q
Radiation therapy causes apoptosis by what 2 mechanisms?
A
Free radical formation and dsDNA breakage
1
Q
DNA laddering is a sensitive indicator of what process?
A
Apoptosis
2
Q
Intrinsic pathway of apoptosis
A
Occurs when a regulatory factor is withdrawn or injurious stimulus is applied; changing ratio of BAX:Bcl-2 leads to MT permeability and CytC release
3
Q
BAX is ___-apoptosis, Bcl-2 is ___-apoptosis
A
Pro; anti
4
Q
What does Bcl-2 bind to prevent CytC release from MT?
A
Apaf-1 (which normally induces the activation of caspases)
5
Q
Extrinsic pathway of apoptosis
A
Either FasL or perforin/granzyme B pathway results in caspase activation; FasL forms FADD to activate caspases
6
Q
Which apoptotic pathway is involved in tissue remodeling and embryogenesis?
A
Intrinsic
7
Q
Which apoptotic pathway is involved in negative selection of T lymphs in the thymus?
A
Extrinsic (FasL)
8
Q
Defects in what interaction are the basis for autoimmune disorders?
A
Fas-FasL (extrinsic apoptotic pathway used in negative thymic selection)
9
Q
Order of protein denaturation and enzymatic degradation in coagulative vs liquefactive necrosis
A
In coagulative necrosis, protein denaturation occurs first; in liquefactive necrosis, enzymatic degradation occurs first
10
Q
Bugs that cause caseous necrosis
A
TB, systemic fungi, Nocardia
11
Q
2 places that get fatty necrosis
A
Pancreas (enzymatic) and breast (non-enzymatic); gets Ca saponification which shows up dark blue on staining
12
Q
2 situations in which fibrinoid necrosis occurs
A
Vasculitides (Henoch-Schonlein, Churg-Strauss) and malignant HTN
13
Q
2 places we get gangrenous necrosis
A
Limbs and GI tract
14
Q
Can membrane blebbing be reversed with O2 administration?
A
Yup
15
Q
Pathologic hallmark of irreversible cell injury
A
Membrane damage
16
Q
Pathologic hallmark of reversible cell injury
A
Cellular swelling
17
Q
Which areas of the brain are most susceptible to ischemic injury?
A
ACA/MCA/PCA boundary areas (watershed zones receiving dual blood supply, susceptible if hypoperfused)
18
Q
Which areas of the heart are most susceptible to ischemic injury?
A
Subendocardium of the LV
19
Q
Which areas of the kidney are most susceptible to ischemic injury?
A
Medullary/straight PCT, medullary TALH
20
Q
Which areas of the liver are most susceptible to ischemic injury?
A
Area around central v. (zone III)
21
Q
Which areas of the colon are most susceptible to ischemic injury?
A
Splenic flexure, rectum
22
Q
2 brain cell types most susceptible to ischemic injury
A
Hippocampal pyramidal cells and cerebellar Purkinje cells
23
Q
Red infarct
A
Occurs in loose tissue with multiple blood supplies (lungs, liver, intestine); Red = Reperfusion
24
Pale infarct
Occurs in solid tissues with a single blood supply (heart, kidney, spleen)
25
First sign of shock
Tachy
26
Cause of shock in the setting of DIC secondary to trauma
Sepsis
27
Distributive shock
Shock in which the vessels can't hold what's being put into them (they're not being good distributors); includes septic, neurogenic, and anaphylactic shock; high output cardiac failure, low PCWP, vasodilation (warm/dry), BP not restored with IV fluids
28
Hypovolemic/cardiogenic shock
Shock in which there's not enough fluid/pumping to supply the tissues; low output cardiac failure, high PCWP (cardiogenic), vasoconstriction (cold/clammy), BP restored with IV fluids
29
5 classic features of inflammation
Rubor (redness), dolor (pain), calor (heat), tumor (swelling) and functio laesa (loss of fx)
30
2 stages of inflammation
Vascular then cellular
31
Cells which mediate acute inflammation
PMNs, eos, Abs
32
Cells which mediate chronic inflammation
Macs, fibros
33
Outcomes of acute inflammation
Resolution, abscess, chronic inflammation
34
Outcomes of chronic inflammation
Scarring, amyloidosis
35
Chromatolysis
Neuronal precursor (usually) to apoptosis, though cell can rarely recover; involves round cell swelling, nuclear peripheral displacement, and Nissl body disintegration
36
Dystrophic calcification
Ca deposition post-necrosis, usually localized; pts are usually normocalcemic (e. g. TB lungs, fat necrosis, congenital CMV)
37
Metastatic calcification
Ca deposition in normal tissues secondary to hypercalcemia (e. g. CKD, sarcoidosis, long-term dialysis)
38
Tissues that usually get metastatic calcifications; why?
Kidney, lungs, and GI; these tissues lose acid quickly and their alkaline interstitium is chemically favorable for Ca deposition
39
Where does extravasation predominantly take place?
PCVs
40
4 steps of leukocyte extravasation
(1) Margination/rolling, (2) tight-binding, (3) diapedesis/transmigration, (4) migration
41
Molecules which help with margination/rolling
E-selectin on vasculature, Sialyl-Lewis on leukocytes
42
Molecules which help with tight-binding
ICAM on vasculature, integrins on leukocytes
43
Molecules which help with diapedesis/transmigration
PECAMs on vasculature/leukocytes
44
3 ways free radicals damage cells
Membrane lipid peroxidation, protein modification, DNA breakage
45
3 most common generators of free radicals
Acetaminophen, Fe, and reperfusion
46
In scar formation, type __ collagen is gradually replaced by type __ collagen; the strongest the scar will ever be is __-__% of its original tensile strength
3; 1; 70; 80
47
Hypertrophic scar
Organized collagen, confined to borders of original wound, won't recur after resection
48
Keloid scar
Increased and disorganized collagen, extending beyond original wound borders, frequently recurs after resection; more common in African-Americans
49
Role of PDGF in wound healing
Secreted by activated platelets and macs to induce vascular remodeling and s. m. migration, stimulates fibros for collagen synthesis
50
Role of FGF in wound healing
Angiogenesis
51
Role of EGF in wound healing
Simulates cell growth via Y kinases
52
Role of TGF-beta in wound healing
Angiogensis, fibrosis, cell cycle arrest
53
Role of MMPs in wound healing
Tissue/ECM remodeling
54
3 general phases of wound healing
Inflammatory -> proliferative -> remodeling
55
During which stage of wound healing does wound contracture occur (if it's going to happen)?
Proliferative (along with the granulation tissue, not later along with remodeling scar formation)
56
2 cells and their 2 mediators which result in granuloma formation
TH1 cells secrete IFN-gamma, and macs secrete TNF-alpha
57
Bugs that cause granulomatous inflammation
B. henselae, F. tularensis, L. monocytogenes, M. leprae, M. tuberculosis, T. pallidum, fungi, schistosomes
58
Exudate
Cellular, protein-rich, SG > 1.020; forms due to lymph obstruction, inflammation, infection, and malignancy; there is vessel abnormality
59
Transudate
Hypocellular, protein-poor, SG < 1.012; forms due to inc hydrostatic pressure (CHF), dec oncotic pressure (cirrhosis), or Na retention; vessels are normal
60
Things that cause a high ESR
Anemias, infections, inflammation (temporal arteritis), cancer (MM), pregnancy, autoimmune disorders (SLE)
61
Things that cause a low ESR
SSA, PV, CHF
62
How does Fe poison someone?
Fe forms toxic O2 radicals which cause peroxidation of membrane lipids
63
Acute Fe poisoning
N/V, GI bleed, lethargy
64
Chronic Fe poisoning
Metabolic acidosis, scarring leading to GI obstruction
65
"Pt takes radiopaque pills leading to metabolic acidosis and GI sx and you can see the pills on X-ray"
Fe OD
66
AL amyloid
Systemic amyloidosis from Ig light chains; occurs in plasma cell disorders (*MM); affects multiple systems including *renal (nephrotic syndrome), cardiac (restrictive), hematologic, GI, and neuro
67
AA amyloid
Systemic amyloidosis from chronic inflammatory conditions like RA, IBD, or protracted infection; multisystem presentation, most often *renal (nephrotic syndrome)
68
AB2m amyloid
Localized dialysis-associated amyloidosis from beta-2-microglobulin (from MHC-1); usually presents as carpal tunnel syndrome (or other joints/tendon sheaths)
69
AF amyloid
Localized heritable (Familial) amyloidosis from transthyretin gene mutation resulting in neuro/cardiac amyloidosis; heterogenous group of disorders
70
ATTR amyloid
Localized age-related/senile cardiac amyloidosis from deposition of normal (wild-type) TTR in myocardium and other sites leading to restrictive cardiomyopathy
71
AB amyloid
AD amyloidosis from APP cleavage
72
Islet polypeptide amyloid
IAPP amyloidosis from T2DM deposition of amylin in pancreatic islets
73
A-Calcitonin amyloid
Calcitonin deposition seen in medullary thyroid carcinoma
74
Lipofuscin
Yellow-brown "wear and tear" pigment found in long-lived cells of old people; perinuclear granules
75
Hallmarks of cancer
Apoptosis evasion, growth signal self-sufficiency, anti-growth signal insensitivity, angiogenesis, limitless replicative potential, tissue invasion, metastasis
76
CIS
Full-thickness dysplasia that has not penetrated the BM
77
How does cancer go from CIS to invasive carcinoma?
Collagenases and hydrolases dissolve the BM
78
P-glycoprotein
AKA multidrug resistance protein 1 (MDR1); expressed by some cancer cells to pump out toxins (chemo agents!)
79
Dysplasia vs anaplasia
Dysplasia has abnormal form and is preneoplastic (reversible); anaplasia has lack of form, cells are more primitive and the change is irreversible
80
Carcinomas that (paradoxically) spread hematogenously
RCC, HCC, choriocarcinoma, follicular thyroid carcinoma
81
Leukemia, lymphoma, melanoma, and seminoma are all ______ neoplasms
Malignant
82
3 chemical mediators of cachexia
TNF-alpha ("cachectin"), IFN-gamma, IL-6
83
Cancer associated with acanthosis nigricans
GI (*stomach)
84
Cancer associated with actinic keratosis
SCC (skin)
85
Cancer associated with AIDS
NHL, Kaposi sarcoma (HHV-8)
86
Cancer associated with autoimmune diseases (Hashimoto, SLE)
Lymphoma
87
Cancer associated with Barrett esophagus
Esophageal adenocarcinoma
88
Cancer associated with chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants
Gastric adenocarcinoma
89
Cancer associated with cirrhosis
HCC
90
Cancer associated with Cushing syndrome
SmCLC
91
Cancer associated with dermatomyositis
Lung cancer
92
Cancer associated with Down syndrome
*ALL, AML
93
Cancer associated with dysplastic nevus
Malignant melanoma
94
Cancer associated with hypercalcemia
SqCLC
95
Cancer associated with immunodeficiency states
Lymphoma
96
Cancer associated with Lambert-Eaton myasthenic syndrome
SmCLC
97
Cancer associated with myasthenia gravis and pure RBC aplasia
Thymoma
98
Cancer associated with Paget disease of bone
Secondary osteosarcoma, fibrosarcoma
99
Cancer associated with Plummer-Vinsen syndrome (low Fe)
SqCC of esophagus
100
Cancer associated with PV
RCC, HCC
101
Cancer associated with radiation exposure
Leukemia, papillary thyroid cancer, breast cancer
102
Cancer associated with SIADH
SmCLC
103
Cancer associated with tuberous sclerosis
Giant cell astrocytoma, renal angiomyolipoma, cardiac rhabdomyoma
104
Cancer associated with UC
Colon adenocarcinoma
105
Cancer associated with xeroderma pigmentosum, albinism
*SCC, Melanoma, BCC
106
BCR-ABL: gene product and associated cancer
Y kinase; CML, ALL
107
Bcl-2: gene product and associated cancer
Anti-apoptotic molecule; follicular/undifferentiated lymphomas
108
BRAF: gene product and associated cancer
Serine/threonine kinase; melanoma
109
c-kit: gene product and associated cancer
Cytokine receptor for stem cell trophic factor; GIST
110
c-myc: gene product and associated cancer
TF; Burkitt lymphoma
111
HER2/neu (c-erbB2): gene product and associated cancer
Y kinase; breast, ovarian, and gastric carcinomas
112
L-myc: gene product and associated cancer
TF; lung tumor
113
N-myc: gene product and associated cancer
TF; neuroblastoma
114
ras: gene product and associated cancer
GTPase; colon, lung, pancreatic cancer
115
ret: gene product and associated cancer
Y kinase; MEN2A/B
116
APC: gene product and associated cancer
c5 TS gene; colorectal cancer/FAP
117
BRCA1: gene product and associated cancer
c17 DNA repair protein; breast/ovarian cancers
118
BRCA2: gene product and associated cancer
c13 DNA repair protein; breast/ovarian cancers
119
CPD4/SMAD4: gene product and associated cancer
c18 DPC (deleted in pancreatic cancer); pancreatic cancer
120
DCC: gene product and associated cancer
DCC (deleted in colon cancer); colon cancer
121
MEN1: gene product and associated cancer
TS gene; MEN1
122
NF1: gene product and associated cancer
RAS GTPase activating protein (neurofibromin); NF1
123
NF2: gene product and associated cancer
Merlin (schwannomin) protein; NF2
124
p16: gene product and associated cancer
CDK inhibitor 2A; melanoma
125
p53: gene product and associated cancer
TF for p21 to block G1 -> S transition; most human cancers, Li-Fraumeni syndrome
126
PTEN: gene product and associated cancer
TS gene; breast, prostate, endometrial cancer
127
Rb: gene product and associated cancer
c13 Inhibits E2F to block G1 -> S transition; retinoblastoma, osteosarcoma
128
TSC1: gene product and associated cancer
Hamartin protein; tuberous sclerosis
129
TSC2: gene product and associated cancer
Tuberin protein; tuberous sclerosis
130
VHL: gene product and associated cancer
c3 inhibition of hypoxia inducible factor 1a (HIF-1a); VHL disease
131
WT1: gene product and associated cancer
TS gene; Wilms tumor (nephroblastoma)
132
WT2: gene product and associated cancer
TS gene; Wilms tumor (nephroblastoma)
133
Only "growth factor" that doesn't have an instrinsic Y kinase attached to it
Growth hormone; it uses a "cytokine-ish" receptor which is associated with JAK-STAT Y-kinase (not intrinsic to, but associated with, the GH receptor)
134
How should tumor markers be used?
Monitor for recurrence or response to therapy, but NEVER as primary diagnostic tool (that can only be done by biopsy)
135
Alkaline phosphatase is a tumor marker for what cancers?
Bone mets, liver, Paget disease of bone, seminoma (placental ALP)
136
alpha-fetoprotein is a tumor marker for what cancers?
HCC, hepatoblastoma, yolk sac (endodermal sinus) tumor, testicular cancer, mixed germ cell tumor (co-secreted with beta-HCG)
137
Beta-hCG is a tumor marker for what cancers?
Hydatidiform moles, choriocarcinomas, testicular cancer
138
CA-15-3/CA-27-29 is a tumor marker for what cancers?
Breast cancer
139
CA-19-9 is a tumor marker for what cancers?
Pancreatic adenocarcinoma (9 backwards looks like P)
140
CA-125 is a tumor marker for what cancers?
Ovarian cancer
141
Calcitonin is a tumor marker for what cancers?
Medullary thyroid carcinoma
142
CEA is a tumor marker for what cancers?
"Could bE Anything!"; colorectal, pancreatic, GI, breast, medullary thyroid carcinoma
143
PSA is a tumor marker for what cancers?
Prostate adenocarcinoma
144
S-100 is a tumor marker for what cancers?
Neural crest tumors (melanomas, neural tumors, schwannomas, Langerhans cell histiocytosis)
145
TRAP is a tumor marker for what cancers?
Hairy B-cell leukemia ("TRAP the hairy animal")
146
Cancers associated with EBV
Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, CNS lymphoma
147
Cancer associated with HBV/HCV
HCC
148
Cancers associated with HHV-8
Kaposi sarcoma, body cavity B-cell lymphoma
149
Cancers associated with HPV
Cervical/penile/anal carcinoma, head/neck/throat cancer
150
Cancer associated with H. pylori
Gastric adenocarcinoma and MALT lymphoma
151
Cancer associated with HTLV-1
Adult T-cell leukemia/lymphoma
152
Cancer associated with liver fluke (Clonorchis sinensis)
Cholangiocarcinoma
153
Cancer associated with Schistosoma haematobium
Squamous cell carcinoma of the bladder
154
Cancer associated with Aspergillus aflatoxin
HCC
155
Cancers associated with alkylating agents
Leukemia/lymphoma
156
Cancer associated with aromatic amines (benzidine, 2-naphthylamine)
Urothelial carcinoma of the bladder
157
Cancers associated with arsenic
Angiosarcoma of liver, lung cancer, SqCC of skin
158
Cancers associated with asbestos
Bronchogenic carcinoma, mesothelioma
159
Cancer associated with carbon tetrachloride
Hepatic centrilobular necrosis, fatty change
160
Cancers associated with cigarette smoke
Urothelial bladder, SqCC/adeno esophagus, RCC kidney, SxCC larynx, SqCC/SmCC lung, adeno pancreatic carcinomas
161
Cancer associated with EtOH
HCC
162
Cancer associated with ionizing radiation
Papillary thyroid carcinoma
163
Cancer associated with nitrosamines (smoked foods)
Gastric cancer
164
Cancer associated with radon
Lung cancer (2nd leading cause after cigs)
165
Cancer associated with vinyl chloride (PVC)
Angiosarcoma of liver
166
Cancers associated with paraneoplastic production of active vitamin D
Hodgkin lymphoma, NHL
167
Cancers associated with paraneoplastic production of ACTH
SmCLC
168
Cancers associated with paraneoplastic production of ADH
SmCLC, intracranial neoplasms
169
Cancers associated with paraneoplastic production of antibodies against presynaptic Ca channels at NMJ
SmCLC (Lambert-Eaton syndrome)
170
Cancers associated with paraneoplastic production of EPO
RCC, thymoma, hemangioblastoma, HCC, leiomyoma, pheochromocytoma
171
Cancers associated with paraneoplastic production of PTHrP
SqCLC, RCC, breast cancer
172
4 cancers that have psammoma bodies
"PSaMMoma" = Papillary carcinoma of thyroid, Serous papillary cystadenocarcinoma of ovary, Meningioma, Malignant mesothelioma
173
Leading cause of cancer deaths in both sexes < 35 y
Leukemia
174
Lung cancer incidence in men compared to women
LC incidence has dropped in men, but has not changed much for women
175
Primary cancer sites that metastasize to the brain
Lung > breast > GU > osteosarcoma > melanoma > GI
176
Primary cancer sites that metastasize to the liver
Colon >> stomach > pancreas
177
Most common sites of metastasis of any cancers after spreading to regional lymph nodes
Lungs and liver
178
Primary cancer sites that metastasize to the bone
Prostate, breast > lung > thyroid
179
Bone metastases usually stick to what portion of the skeleton?
Axial skeleton (where hematopoiesis and increased blood flow/stasis are still taking place)
180
Prostatic mets to bone are _______; breast mets to bone are ______
Blastic; mixed blastic/lytic
